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| PERSPECTIVE/VIEWPOINT |
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| Year : 2019 | Volume
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| Issue : 1 | Page : 47-49 |
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Social psychiatry in the era of sustainable development
Shekhar Saxena
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| Date of Submission | 29-Jun-2019 |
| Date of Decision | 01-Jul-2019 |
| Date of Acceptance | 08-Jul-2019 |
| Date of Web Publication | 27-Sep-2019 |
Correspondence Address:
Prof. Shekhar Saxena
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
USA
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WSP.WSP_4_19
We currently live in an era when sustainable development is a high priority. Inclusion of mental health and well-being in the United Nation's Sustainable Development Goals presents an unprecedented opportunity to bring mental health out of shadows into the larger arena of development. Social psychiatry can play a large role in ensuring that that these opportunities are utilized fully by working more closely with professionals from other areas within and outside health sectors as well as with communities including people with lived experience.
Keywords: Development, goals, psychiatry, social, sustainable
How to cite this article:
Saxena S. Social psychiatry in the era of sustainable development. World Soc Psychiatry 2019;1:47-9 |
| Introduction | |  |
United Nation's Sustainable Development Goals (SDGs)[1] represent a new and a far more comprehensive vision of development for all countries than their predecessor – the Millennium Development Goals.[2] Promoting mental health and well-being has been recognized in SDGs as an integral part of the goal related to health; this is a testimony to the increasing recognition of the importance of mental health not only within health but also within the overall developmental agenda. Since SDGs are conceptualized as integrative and indivisible, promoting mental health and well-being has to be viewed as a responsibility of the entire development sector rather than only of mental health professionals. This presents unprecedented opportunities but also a few challenges as described recently in the Lancet Commission on Global Mental Health and Sustainable Development.[3] This commentary briefly examines some of these issues from the perspective of social psychiatry.
The definition of health in the constitution of World Health Organization[4] already included mental and social well-being as early as in 1948. Psychiatry has also been seen as a specialty of medicine that needed to pay far more attention to the social and interpersonal dimension of people than others. Social psychiatry has been a recognized as a substantive discipline for many decades. So, what is new? In the opinion of the author, we are living in times when there is not only “no health without mental health” but also “no development without mental health.” Mental health professionals in general but social psychiatrists in particular need to embrace this concept to realize fully the potential that has been created to advance their objectives. Let us examine a few broad implications of this.
| Mental Health as a Public Good | | |
Mental health should be viewed as a universal human attribute, important to all people in all countries at all ages and as a key contributor to human capital. This concept recognizes mental health as a dimension rather than as a binary phenomenon. The world cannot simply be divided into two groups – one with mental disorders and other without. The practical implication of this is that we can all do something about our mental health. If we do not (yet) have a mental health problem or disorder, we can enhance our mental health. If we have some problem but not a disorder or we have some known risk factors, we can take preventive steps to decrease the chances of a mental disorder. Finally, if we already have a mental disorder or a psychosocial disability, we can manage it and strive toward recovery.
| Mental Health as a Human Right | | |
Though several United Nations resolutions have recognized enjoyment of the highest attainable standard of physical and mental health as a right of every person,[5] the concept of mental health as a developmental goal enhances the scope of obligated actions that governments need to take as a part of their development efforts. The discussion is moving from the right for treatment to the right for preventive and promotive interventions. It is important that the rights-based framework is implemented in active, full, and meaningful involvement of communities including and especially of persons with lived experience of mental health problems.[6]
| Social Determinants of Mental Health | | |
It has been recognized for a long time that social, demographic, and economic factors influence the prevalence, nature, and outcome of a variety of mental disorders. The evidence for these associative links with risk factors that are causal in many but not all cases has been building up.[7] These determinants are operative at all ages but are especially influential during formative years of childhood and adolescence.[3] There is also an accumulation of evidence for effectiveness of interventions to decrease the negative impact of these risk factors and to enhance the positive impact of protective factors.[3] These actions, mostly at policy level, are almost invariably within sectors other than health, and the SDGs provide a robust and convincing framework to develop and implement these policies. Most countries have developed or are developing their plans for achieving the SDGs, and mental health professionals can play a critical role in investigating, summarizing, and conveying the evidence to decision makers and to advocate for appropriate social policies for promoting mental health. Examples of these actions include providing financial protection to people and families with mental disorders (related to SDG1: End poverty), providing early child stimulation (related to SDG4: Education), and implementing workplace mental health programs (related to SDG8: Employment and work). A comprehensive list of actions for protecting mental health for the relevant SDGs is available.[3]
| Mental Health as a Component of Universal Health Coverage | | |
Lack of sufficient mental health services is a global phenomenon; but, the situation is particularly alarming in most low- and middle-income countries where the vast majority of people with mental disorder do not receive any treatment.[8] The high-level endorsement of universal health coverage (UHC) within SDGs provides an unprecedented opportunity to mainstream mental health within health services.[9] As international organizations accept this principle[10] and as national ministries of health prepare their UHC packages, it is important for the socially minded mental health professionals to ensure that mental health is not forgotten.
| Integrative and Innovative Research | | |
Although knowledge into causes as well as interventions in mental health field has enhanced substantially in the last few decades, a lot more remains to be known.[11] In particular, the enormous potential of convergence between genetic, biological, neuroscience, clinical, and social streams of research is just about beginning to be harnessed.[3] Social psychiatry researchers can play an important role in facilitating this process by collaborating with researchers from other streams and by ensuring that their findings are amenable to be integrated within larger framework of causal pathways and innovative delivery of interventions.
| Monitoring and Accountability | | |
Finally, reliable, valid, and transparent mechanisms need to put into place to monitor the progress made (or the lack of it) in mental health at global, national, and local levels.[12] In addition, accountability needs to be established for existing and future investments in mental health; this is especially relevant if resources are expected from the development sector. Social psychiatrists can contribute to this process by providing their expertise in selecting socially relevant indicators such as equity, human rights, and satisfaction with care.
Mental health has remained in the shadows for far too long. Its inclusion in SDGs provides an opportunity for mental health professionals to enlarge the scope of their expertise and actions to contribute to enhancing the mental health of communities that they serve. Social psychiatry can play a large role in ensuring that these opportunities are utilized fully. This requires working more closely with professionals from other areas within and outside health sectors as well as with communities including people with lived experience.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | |
| 2. | |
| 3. | Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The lancet commission on global mental health and sustainable development. Lancet 2018;392:1553-98.  |
| 4. | |
| 5. | |
| 6. | Sunkel C, Saxena S. Rights-based mental health care. Lancet Psychiatry 2019;6:9-10. |
| 7. | Lund C, Brooke-Sumner C, Baingana F, Baron EC, Breuer E, Chandra P, et al. Social determinants of mental disorders and the sustainable development goals: A systematic review of reviews. Lancet Psychiatry 2018;5:357-69. |
| 8. | Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, et al. Undertreatment of people with major depressive disorder in 21 countries. Br J Psychiatry 2017;210:119-24. |
| 9. | |
| 10. | |
| 11. | Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar AS, et al. Grand challenges in global mental health. Nature 2011;475:27-30. |
| 12. | Saxena S, Kestel D, Sunkel C, London E, Horton R, Patel V, et al. Countdown global mental health 2030. Lancet 2019;393:858-9. |
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